russian skater
© FT montage; AFP
Skaters in Moscow's Red Square. More than 36 per cent of the population aged between three and 79 years now practise sports regularly, up from just 22.5 per cent in 2012
Strictly speaking, using dumbbells outside the gym is forbidden. But the gym at the Youth Residential Complex Butovo gets so crowded that some weightlifters spill out into the corridor.

Every weeknight, people from the surrounding high-rises pour into this cramped basement for fitness training or boxing. "We're bursting at the seams," says Sergei Popovkin, manager of the sports centre and a former karate trainer. "When we opened in 1991, we would get 100 people a month. Now it's more than three times that number, plus another 200 for fitness alone."

The sports craze in Butovo, a residential suburb on the southern fringes of Moscow, reflects the enthusiasm for a healthy lifestyle that has gripped millions in Russia. "People really care about their health now - they've stopped drinking vodka and started eating kiwis," says Mr Popovkin.

The decade of economic depression that followed the collapse of the Soviet Union in 1991 took a heavy toll on Russian health.

Poverty, heavy drinking and smoking combined with poor healthcare contributed to the death of millions of Russians in their prime. Now as Vladimir Putin seeks re-election on Sunday for a fourth term, he is casting himself as the man who helped bring about a national rebirth - claiming credit for higher birth rates and a healthier population.

Life expectancy has risen to 73 years from almost 65 in 2003, a pace among the fastest in the world, Mr Putin said at his state of the nation speech this month. In the coming years, the country needed "to make a quantum leap in its development, so that the life of every person is transformed", he said.

For Mr Putin, promoting a healthy lifestyle has proven a strong, credible vehicle for rallying his political base, particularly with a generation where his support is more fragile. "Healthy people and healthy habits - you may take that as a metaphor for a strong nation, and there is no doubt that is what every Russian wants," says a Kremlin official.

Mr Putin's aides have carefully crafted an image for the president as a physically fit man who loves sport and nature. Repeatedly during the campaign, Mr Putin has surrounded himself with prominent Russian athletes. But beyond such propaganda, Russia's rebirth is real and economists say Mr Putin's government deserves credit for at least part of it. Smoking and drinking have fallen sharply, following government restrictions on tobacco and alcohol sales.

The sports ministry announced last week that 50m Russians - more than 36 per cent of the population aged between three and 79 years - now practise sports regularly, up from just 22.5 per cent in 2012. More affluent Russians often seek treatment abroad but quality private medical services are increasingly on offer in Moscow and St Petersburg. However, such improvements remain out of reach for millions of Russians.

In some remote Siberian territories, male life expectancy still lingers under 60. Alcohol-related morbidity remains stubbornly high in some regions, while deaths at working age far exceed the national average. The 2015-16 recession forced many regional governments to cut social expenditure to the bone. In Verkhnechusovskie Gorodki, a rural settlement in the Urals, the local hospital hasn't had any repairs or upgrades in a decade, and can perform only basic services on Soviet-era equipment.

Authorities have closed the in-patient ward and retired the local ambulance. "My mother has problems with her back and needs regular MRT examinations," says Anna Sushko, a 33-year-old resident. "Waiting for her turn at the state-funded hospital will take too long to do it in time, so she has to go to the regional capital, 100km away. The MRT costs Rbs2,500, and transport costs about that each way. Add to that the cost for a meal, since she'll be on the road a whole day, and her entire monthly pension is gone."

The government acknowledges the problem. Mr Putin has promised to double healthcare spending between 2019 and 2024 to more than 4 per cent of GDP. Andrei Nikitin, governor of Novgorod Oblast, a thinly populated region between Moscow and St Petersburg, says many patients who come to the hospital with one complaint are diagnosed with neglected diseases that are not captured by screening programmes due to the remote locations they live in.

He hopes to tackle this problem with mobile clinics and with digital systems that can help monitor patients remotely. The Russian exclave of Kaliningrad has similar plans. With the help of an intensive oncological screening programme, the government there hopes to drive life expectancy to above 80 years within a decade.

Some analysts are deeply sceptical. "The underfinancing of our health system is chronic, and it continued in the past even when funds were approved for priority projects," says Yevgeny Gontmakher, a prominent economist. He believes that Russia's health spending would need to rise to 7 per cent of GDP, levels similar to EU countries, to meet the challenge.

But at least for now, Mr Putin is piling on the pressure. Healthcare restructuring that left rural people without affordable medical services was "unacceptable", he thundered in his speech. "We must provide, or restore where necessary, easy access to primary healthcare. This must be done as quickly as possible."